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LAND USE PERMIT APPLICATION — Burnett County, WI a C b <br /> Applicant Complete All Sections Below This Line c wNi <br /> Permit Types and Fees(Please,check appropriate boxes). G <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 CDQ <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 "b p <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 �Q <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $150 It ,I �-- <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 < �ot <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(ly)Structures $350 o U <br /> Filling/Grading $150 Boathouse $500 1 <br /> Solar Panels(Stand alone or roof mounted) $150 Permit Extension(1 Year Extension-Allowed Once) $100 W <br /> NOTE:After-the-fact permits(permit acquired after construction has begun)may cost up to three times the normal fee. <br /> ro <br /> *Communication Towers,Camping Permits&Signs require a different application form,see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> z <br /> 0 <br /> Property Owner's Name: <br /> 0 <br /> 1 0 <br /> Property Owner's Mailing Address:j.:�& <br /> ity <br /> in State Zip ° <br /> Property Site Address: C o N <br /> c <br /> Contact's Telephone Number: <br /> d <br /> Contact's Email: <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is ro <br /> legible and your email provider will accept emails from the follow address: @BurnettCountyWI. ov 74 <br /> Legal Description of Proper b <br /> Section Town#: N Range#:_J_�_W Town of:Q- �K�-, _ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> � o � <br /> Tax ID#(1-5 digit number;found on tax statement): Q G <br /> 0 <br /> Proposed Use of Structure/Addition: e ' H <br /> Anticipated Start Date. (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> _ W ` <br /> Building Contractor: Sewer Installer: \ V� <br /> y <br /> AREA BELOW THIS LINE FOR LAND RERIACRS STAFF COMMENTS/C NDITIONS ONLY m <br /> z � <br /> THIS PERMIT IS S�VBJECT TO ALL C N�1 IONS LISTED BELOW: z W <br /> lVpf 7o O� US 7�1/' `jU►Mr/�I a i Off. <br /> (PGock emd INs7,�//eol m,4 s�plli� rH� 6y /////2025-, CC <br /> y G <br /> 15b.06 <br /> Fee Rec.: <br /> °z Check#: �Gf ) <br /> r- <br /> M <br /> v r <br /> ,t ZD Z� Initi is of s' visit staff: i <br /> Date of staff site visit: 9 T L�8' FU <br /> 0 W C <br /> APPROVED BY LAND SERVICES OFFICIAL: DATE: z 3 � <br /> Zn <br /> UPON APPROVAL: APPL CANT MUST POST COPY OF <br /> 00 <br /> 3� N C <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT _ "'Page 1 of 5 J <br /> Burnett County,WI Land Use Application—Rev 11/2024 <br />